However, leaders in health care have identified many rural areas that are underserved by doctors and hospitals, meaning a longer commute that could endanger lives.

“If you have a cold or the flu, (distance) is not important, but if you have a heart attack, it’s a much bigger issue,” said Alan Morgan, executive director of the National Rural Health Assoc. (NRHA). “In a farm implement accident, the time it takes to receive medical care is a life or death issue.”

The NRHA, based in Kansas City, Mo., is busy fighting for funding that would bring doctors and clinics to small communities and the farms that are near them. Based on President Bush’s budget proposal, the House will consider cuts to federally funded rural health care this year. This proposal follows cuts in rural health care in the last budgetary session of Congress.

“The last budget cycle drastically cut primary care (such as family doctors). This is the access point where we see better outcomes at a lower cost. If you see a specialist later, it is more costly,” said Sarah Snider, administrator at the Richard G. Lugar Center for Rural Health in Terre Haute, Ind.

Also affecting the quality of care for farmers is their insurance, Morgan said.

“The vast majority of farmers are self-insured. They have a higher deductible and higher co-pays... They may put off medical care. Usually the sooner you treat a problem, the less of a problem you have,” Morgan explained.

As a result, Morgan said rural communities tend to have severe tooth loss and more chronic illnesses, such as heart disease and diabetes.

“On a good note, in health care services in rural areas, the quality of care is better. They don’t have the volume (of patients) that drives medical errors,” Morgan said.

Training for rural doctors

The Lugar Center, an outreach of Union Hospital, provides training for physicians who plan to go into rural practice. Snider said the center’s funding was cut by 12 percent this year and next year’s funding is uncertain.

“We are the only residency program in Indiana with accreditation and a rural training track,” Snider said. “We are at our maximum (capacity) with six graduates per year. Most are staying in the state.”

She said there are 53 federally designated rural health clinics in Indiana. They are funded in various ways and may be affected by cuts differently.

Despite the fact that many rural communities are trying to recruit physicians, Snider said the majority of doctors are headed in the opposite direction.

“Many physicians are going to urban areas. Many are not trained in rural needs. Urban doctors have a library down the hall and a cardiologist down the street. They can get a good living,” Snider said.

Even if a doctor wants to go to a rural area, he may not be equipped to do so, leading to burn out, Snider said.

“A rural physician does not have the same resources as a doctor in an urban setting. There isn’t an obstetrician or gynecologist or critical access nearby. The Lugar Center prepares them to know when a patient is stable and can be sent out,” Snider said.

She said traditional medical schools do not provide training or experience for these common rural situations.

Despite the documented need for more rural health care, Snider said the funding for primary care and rural training is constantly at risk for cuts. The financial pressure alone has closed the doors of some rural centers, she said.

“When we know we have a crisis in rural care – a shortage of providers – we need to take a hard look at what we’re doing nationally.

“We get better outcomes at a lower cost with primary care, and we’re cutting the viability of those programs. We need to look at meeting our priorities and not have a knee-jerk reaction,” Snider said.

Midwest Congressmen such as Rep. Mike Pence (R-Ind.) and Mike Sodrel (R-Ind.) said they were studying the issue, but weren’t prepared to speak on any specifics.

“Congressman Pence supports funding for rural health care as long as it doesn’t continue Congress’ habit of overspending,” said Matt Lloyd, communications director for Pence.